Urge your Member of Congress to Support the Legislation to Treat Children with Deformities

Private insurers are increasingly denying coverage for corrective procedures to address craniofacial anomalies because they are classified as cosmetic and do not consider treatment for the condition to be medically necessary.

The Children's Access to Reconstructive Evaluation & Surgery (CARES) Act of 2007 (HR 1655/S. 1588) has been introduced and would expand private payer coverage of craniofacial anomalies by requiring that group and individual health insurance coverage and group health plans that offer surgical benefits provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease.

Please contact your constituent Senators and Representative and ask them to co-sponsor the HR 1655 and S. 1588 to make treatment for congenital craniofacial anomalies a covered benefit. Please personalize the sample message below with your own comments or patient experiences. Thank you!

Note: E-mails sent through this initiative will be directed towards your constituent Members of Congress. If you have questions on this campaign, please feel free to contact AAOMS governmental affairs staff at 800/822-6637.

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Talking Points

Private insurers are increasingly denying coverage for corrective procedures to address craniofacial anomalies because they are classified as cosmetic and do not consider treatment for the condition to be medically necessary.
The Children's Access to Reconstructive Evaluation & Surgery (CARES) Act of 2007 (HR 1655/S. 1588) would require insurance coverage for reconstructive surgeries for persons age 21 and under.
Reconstructive surgeries would include those to treat craniofacial anomalies. The most widely known craniofacial conditions are cleft lip and palate. These conditions may appear to be cosmetic, but they often impede a child's daily functioning, such as their ability to chew food or have normal speech.
Oral and maxillofacial surgeons and other specialists who treat children with craniofacial disorders frequently donate their time and services to help children whose families cannot otherwise afford treatment. This should be a covered service for insured patients.
The bill would set an immediate, national standard of health care coverage for children with craniofacial anomalies by making changes to ERISA, the Public Health Service ACT and the Internal Revenue Code, which will avoid a prolonged, state-by-state battle.

Subject:

Dear [ Decision Maker ],

(Edit Letter Below)

As an oral and maxillofacial surgeon and constituent in your district, I respectfully urge you to co-sponsor the Children's Access to Reconstructive Evaluation & Surgery (CARES) Act of 2007(HR 1655/S. 1588), which would protect and promote access to treatment for childhood deformities and craniofacial abnormalities such as cleft lip and palate.

The bi-partisan CARES Act specifically would set an immediate, national standard of health care coverage for children with craniofacial anomalies by amending the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans that offer surgical benefits to provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor or disease. Currently, only 14 states require insurance companies to cover craniofacial anomalies and this reasonable legislation would avoid a prolonged, state-by-state battle.

According to the Surgeon General's September 2000 report, Oral Health in America, craniofacial anomalies affect an estimated one in 600 children every year in America, with the most widely known craniofacial conditions being cleft lip and palate. Craniofacial anomalies may "appear" to be only cosmetic, but this condition often impedes a child's daily functions, such as chewing food and normal speech.  Unfortunately, an increasing number of insurance companies are denying access to reconstructive surgery for children with craniofacial deformities because they do not consider treatment for the condition to be medically necessary.

While many oral and maxillofacial surgeons and other specialists who treat children with congenital craniofacial disorders frequently donate their time and services to help children whose families otherwise cannot afford treatment, there are thousands who are currently covered under health insurance plans but are not able to receive corrective surgery because their claims are denied by insurers on the basis that the procedure is deemed "cosmetic."

Each day this legislation languishes in Congress is another day children without the necessary financial means go untreated for debilitating abnormalities. Therefore, on behalf of all the children who will benefit from this legislation, I urge you to co-sponsor the CARES Act (H.R. 1655/S. 1588) and encourage action on the bill this Congressional session.

Sincerely,
[Your name]
[Your address]

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